Surgical Management of Lung Cancer Flashcards
What might be included in the history for someone with lung cancer?
Bony Pain
headaches,
neurological symptoms including personality change. Haematuria
What might you notice during an examination of someone with lung cancer?
Recurrent laryngeal palsy,
brachial plexus palsy
SVCO
Supraclavicular lymph nodes,
soft tissue nodules,
chest wall masses.
Pleural/pericardial effusion.
Hepatomegaly
What is recurrent laryngeal nerve palsy?
Paralysis of the larynx (voice box)
Caused by damage to recurrent laryngeal nerve/vagus nerve
Originates in brainstem & runs down to colon.
Recurrent laryngeal nerve supplies larynx (voice box).
What can a chest X-ray indicate?
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung
What can blood tests indicate?
Anaemia
Abnormal LFTs (liver function tests)
Abnormal bone profile
What does a CT scan show you?
Size of tumour
Mediastinal nodes
Metastatic disease (other parts of the lungs, liver, adrenals or kidneys)
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement
What other tests besides X-ray, blood tests and CT scans might help a diagnosis?
MRI
Bone Scan
ECHO
What is an MRI useful for?
Determining degree of vascular & neurological involvement in pancoast tumour
What is a Bone scan a good test for?
Good test for chest wall invasion & for bony metastases
What is an ECHO good for?
Demonstrating presence or absence of significant pericardial effusion.
What are the surgical methods of lung cancer staging?
Bronchoscopy
Mediastinoscopy
What considerations would you have to make before operating?
CVS, respiratory, psychology
Any diseases or problems to do with these stuff
What are the respiratory function tests needed to assess fitness for surgery?
Spirometry
Diffusion studies
ABG on air/SLV
Fractioned V/Q scan
What is ABG?
Arterial blood gas (ABG)
sampling of blood levels of oxygen & carbon dioxide within the arteries, opposed to venous blood.
Acidity, or pH, of the blood is measured simultaneously with the gas levels in ABG sampling.
How do you assess someones heart before surgery?
ECG - (electrocardiogram)
ECHO - echocardiography - ultrasound of the heart
CT scan
ETT - (exercise tolerance test, exercise ECG)
Coronary angiogram
What must be determined before resection?
Firm diagnosis of malignancy
What is the goal in surgical treatment of cancer?
Curative resection, with minimal removal of lung tissue
Is resection of the parietal structures possible?
Yes, feasible
What is peri-operative death?
Death within 2 weeks of a surgical procedure
What are the reasons for peroperative death?
ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding
What is ARDS?
Acute respiratory distress syndrome
Condition that leads to low oxygen levels in blood.
Fluid builds up in the air sacs
prevents lungs from filling with air & moving enough oxygen into bloodstream.
What does PTE stand for?
Pulmonary thromboembolism
What non-fatal complications exist after an operation?
Pain
Empyema
BPF
Wound infection
AF
MI
Post-op respiratory insufficiency
Gastroparesis/constipation.
What does BPF stand for?
Bronchopulmonary fistula
What does MI stand for?
Myocardial infarction
What is gastroparesis?
Spontaneous movement of the muscles (motility) in your stomach does not function normally
When is it difficult to assess the size of a tumour?
Because of collapse of a lobe or lung
What are the commonest problems with staging of lung cancer?
Presence of another pulmonary nodule
Retrosternal thyroid
Adrenal Nodule - benign tumour in the adrenal gland
What is a retrosternal thyroid?
The abnormal location of all or part of the thyroid gland below the breastbone (sternum)
Define pneumonectomy
Surgical removal of a lung or part of a lung.
When might be confused for cancer?
Tb, lung abscess Benign tumour - hamartoma Granuloma Fibrosis Paraffinoma
Define hamartoma
Disorganised mass of cells. The cells are the same as those found in the local area, non- malignant. Growth rate is equal to that of the surrounding area
Define parrafinoma
Injection of paraffin causing a tumefaction, usually a granuloma
What is the operative mortality rates for lung cancer
Pneumonectomy 5-10%
Lobectomy 3-5%
Wedge resection 2-3%
Open/ close thoracotomy 5%
